Hematocrit During Cardiopulmonary Bypass

ArticleinThe Annals of thoracic surgery 82(3):1166; author reply 1166 · October 2006with4 Reads
DOI: 10.1016/j.athoracsur.2006.01.074 · Source: PubMed
    • "Aside from a number of studies examining the impact on cognition of anemia (Chaves et al., 2006; Zamboni et al., 2006) or alterations in blood glucose levels (Awad, Gagnon, & Messier, 2004; Cox et al., 2005; Draelos et al., 1995; Hiltunen, Keinanen-Kiukaanniemi, & Laara, 2001; Pais et al., 2007; Perlmuter et al., 1984; Shorr et al., 2006; Sommerfield, Deary, & Frier, 2004), the extent of cognitive change expected with abnormalities in serum chemistries has not been well studied. Investigations that do include evaluation of other serum chemistries typically use relatively crude outcome measures indicating the presence or absence of delirium (Eden, Foreman, & Sisk, 1998; Granberg, Malmros, Bergbom, & Lundberg, 2002; Inouye et al., 1993; Watts, Roberts, & Parsons, 2007) or measure serum chemistries in specific populations (Boodhwani et al., 2006; Harrison, Stygall, Whitaker, Grundy, & Newman, 2006; Swaminathan et al., 2002; Zuccala et al., 2005). The degree of change is typically not quantified and subtle changes are overlooked. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of this study was to examine the relationship between common laboratory values and cognitive functioning among 129 inpatients referred for neuropsychological evaluation. Laboratory values were recorded at admission, at the time point closest to neuropsychological evaluation, and at the time of peak metabolic derangement. Cognitive status was evaluated with the modified Mini-Mental State Exam. Patients with hyperglycemia, hypochloremia, and/or elevated creatinine at admission exhibited cognitive deficits. Patients with hyperglycemia, hyperchloremia, hypernatremia, hyperkalemia, leukocytosis, low hemoglobin, elevated blood urea nitrogen, and/or elevated creatinine at the time of peak metabolic derangement exhibited cognitive deficits. Different lab abnormalities at the time of peak metabolic derangement accounted for unique patterns of neuropsychological impairment. Lab values drawn at the time point closest to neuropsychological evaluation were not significantly associated with cognitive functioning. Results support and quantify common clinical beliefs that metabolic abnormalities are associated with global cognitive changes among elderly inpatients.
    Article · May 2009
  • [Show abstract] [Hide abstract] ABSTRACT: Strategies for neuroprotection including hypothermia and hemodilution have been routinely practiced since the inception of cardiopulmonary bypass. Yet postoperative neurocognitive deficits that diminish the quality of life of cardiac surgery patients are frequent. Because there is uncertainty regarding the impact of hemodilution on perioperative organ function, the authors hypothesized that extreme hemodilution during cardiac surgery would increase the frequency and severity of postoperative neurocognitive deficits. Patients undergoing coronary artery bypass grafting surgery were randomly assigned to either moderate hemodilution (hematocrit on cardiopulmonary bypass >or=27%) or profound hemodilution (hematocrit on cardiopulmonary bypass of 15-18%). Cognitive function was measured preoperatively and 6 weeks postoperatively. The effect of hemodilution on postoperative cognition was tested using multivariable modeling accounting for age, years of education, and baseline levels of cognition. After randomization of 108 patients, the trial was terminated by the Data Safety and Monitoring Board due to the significant occurrence of adverse events, which primarily involved pulmonary complications in the moderate hemodilution group. Multivariable analysis revealed an interaction between hemodilution and age wherein older patients in the profound hemodilution group experienced greater neurocognitive decline (P = 0.03). In this prospective, randomized study of hemodilution during cardiac surgery with cardiopulmonary bypass in adults, the authors report an early termination of the study because of an increase in adverse events. They also observed greater neurocognitive impairment among older patients receiving extreme hemodilution.
    Article · Oct 2007
  • [Show abstract] [Hide abstract] ABSTRACT: Blood has been described as the most precious and personal substance in the world. Current directions in cardiac surgery are moving away from transfusing donor "Allogeneic" blood products, and towards improving methods of saving and preserving the patient's own "autologous" blood. Nothing else comes close to the natural healing abilities and homeostasis that one's own whole blood offers. No substitute, whether it is human or artificial, will ever work as well with fluid shifts, hemostasis and homeostasis. News reports today commonly feature severe blood shortages and research documenting recognized transfusion risks such as how older stored blood can put heart surgery patients at increased risk and others that point to the morbidity and mortality associated with its use. Therefore the medical community is moving towards more effective blood utilization by minimizing the exposure to donated blood. Current techniques are saving as much as possible of the patient's own blood that might otherwise be mismanaged or lost during surgery. Techniques, such as Ultrafiltration, that quickly concentrate and reinfuse whole blood back to the patient are the best choice. Admission to discharge hemovigilance requires a concerted multidisciplinary team effort with multimodal tools available in the coagulation armamentarium to effectively avoid this form of organ transplant. Improving outcomes and reducing morbidity and mortality in cardiac surgery takes place at the microcirculatory capillary level and with control of Hemostasis. Cardiac teams need to effectively communicate and minimize blood loss and hemodilution and reverse it, for state of the art blood management in Cardiac surgery.
    Article · Jul 2009